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Alcohol Use Trajectories and Problem Drinking Over the Course of Adolescence: A Study of North American Indigenous Youth and Their Caretakers
No full textThis study investigated the links between alcohol use trajectories and problem drinking (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition abuse/dependence) using five waves of data from 727 North American Indigenous adolescents between 10 and 17 years from eight reservations sharing a common language and culture. Growth mixture models linking fundamental causes, social stressors, support, and psychosocial pathways to problem drinking via alcohol use trajectories over the early life course were estimated. Results indicated that 20 percent of the adolescents began drinking at 11 to 12 years of age and that another 20 percent began drinking shortly thereafter. These early drinkers were at greatly elevated risk for problem drinking, as were those who began drinking at age 13. The etiological analysis revealed that stressors (e.g., perceived discrimination) directly and indirectly influenced early and problem alcohol use by decreasing positive school attitudes while increasing feelings of anger and perceived delinquent friendships. Girls were found to be at risk independently of these other factors
Who Are America’s Poor Children? Examining Health Disparities by Race and Ethnicity
No full textGood health in childhood both reflects and predicts full social and economic participation. Conversely, social divisions by race and income are often associated with health disparities, which inhibit children from achieving their full potential. Although many would agree that health is a fundamental right, children subject to exclusion by race and class are less likely to enjoy this right.
An earlier report in the NCCP Who are America’s Poor Children? series examined child health disparities by poverty status. In the introduction to that report two points were made. First, “the relationship between socioeconomic status and health is one of the most robust and well documented findings in social science
Disparities in Smoking Are Complicated and Consequential. What to Do About Them?
No full textAs a fundamental matter of social justice, Americans worry about health disparities experienced by racial/ethnic minorities, the poor, and other minority groups. Typically concerns focus on inequalities in access to high-quality health care and on often large differences in health outcomes. Ironically, with the exception of the tobacco control community (indeed, probably only a subset of it), Americans express little concern about disparities in smoking prevalence and cessation among groups differentiated by race/ethnicity, socioeconomic status, mental health, or sexual orientation.
Why is this ironic? Because the health consequences attributable to differences in smoking rates likely account for a significant proportion of disparities in important health outcomes, like life expectancy
Quitline Utilization Rates of African-American and White Smokers: The California Experience
No full textPurpose. To compare the utilization rate of a statewide tobacco quitline by African-American smokers to that of white smokers.
Design, Setting, and Subjects. Observational study of 18 years of state quitline operation in California. Subjects were 61,096 African-American and 279,042 white smokers who called the quitline from August 1992 to December 2009. Data from six California Tobacco Surveys, 1993, 1996, 1999, 2002, 2005, and 2008 were also used.
Measure. Callers' answers to the question how they heard about the quitline were grouped into four categories: media, health care providers, friends/family, and others.
Analysis. The averaged annual quitline call volume for each ethnic group was divided by the total number of smokers in that group, based on California Tobacco Surveys, to produce the annual quitline utilization rate.
Results. In five out of six periods of comparison, African-American smokers had a higher annual utilization rate than white smokers. The odds ratios [ORs] ranged from 1.44 to 2.40 (all p < .05). In the 1996 comparison, the OR was .90 (p <.05). The difference in utilization rates that is attributed to media, accounts for most of the difference in total utilization rates between the two ethnic groups.
Conclusions. Within the context of California's comprehensive tobacco control program, which includes a strong media campaign, African-American smokers were significantly more likely to call the state quitline than white smokers were. Promoting the quitline as part of antismoking media campaigns can help reduce disparity in cessation service utilization
Provider Smoking Cessation Advice Among California Asian-American Smokers
No full textPurpose. To determine proportions of provider advice to quit smoking for Asian-American smokers and to describe factors that may affect the provision of such advice.
Design. Secondary data analysis of population-based survey.
Setting. California.
Subjects. Current smokers from the California Tobacco Use Surveys for Chinese-Americans (n = 2117, participation rate = 52%), Korean-Americans (n = 2545, participation rate = 48%), and Vietnamese-Americans (n = 2179, participation rate = 63.5%).
Measures. Sociodemographics including insurance status, smoking frequency, provider visit in past year, and provider advice to quit.
Analysis. Multivariate logistic regression models examined dependent outcomes of (1) provider visit in past year and (2) provider advice to quit.
Results. Less than a third (30.5%) of smokers in our study reported both seeing a provider (50.8%) and then receiving advice to quit (60.1%). Factors associated with provider visits included being female, being 45 years or older, having health insurance, and being Vietnamese. Among smokers who saw a provider, factors associated with provider advice to quit included having health insurance and being a daily smoker.
Conclusions. Asian-American smokers reported low proportions of provider advice to quit in the past year, largely because only half of smokers saw a provider. Providers who see such smokers may need greater awareness that several effective cessation treatments do not require health insurance, and that intermittent smokers need advice to quit
Are There Racial Differences in Patients' Shared Decision-Making Preferences and Behaviors among Patients with Diabetes?
No full textBackground. In the United States, African Americans are more likely to experience lower quality patient/provider communication and less shared decision making (SDM) than whites, which may be an important contributor to racial health disparities. Patient factors have not been fully explored as a potential contributor to communication disparities. Methods. The authors analyzed cross-sectional data from a survey of 974 patients with diabetes seen at 34 community health centers (HC) in 17 midwestern and west-central states. They used ordinal and logistic regression models to investigate racial differences in patients’ preferences for SDM and in patients’ behaviors that may facilitate SDM (initiating discussions about diabetes care). Results. The response rate was 67%. In bivariate and multivariate analyses, race was not associated with patient preference for a shared role in the 3 measured SDM domains: agenda setting (odds ratio [OR]: 1.13 [0.86, 1.49]), information sharing (OR: 1.26 [0.97, 1.64]), or decision making (OR: 1.16 [0.85, 1.59]). African Americans were more likely to report initiating discussions with their physicians about 4 of 6 areas of diabetes care—blood pressure measurement (66% v. 52%, P < 0.001), foot examination (54% v. 47%, P = 0.04), eye examination (57% v. 46%, P = 0.002), and microalbumin testing (38% v. 29%, P = 0.01)—but not HbA1c testing (39% v. 43%, P = 0.31) or cholesterol testing (53% v. 51%, P = 0.52). In multivariate analysis, African Americans were still more likely to report initiating conversations about diabetes care (OR: 1.78 [1.10, 2.89]). Conclusions. The authors found that African Americans in this study preferred shared decision making as much as whites and were more likely to report initiating more discussions with their doctors about their diabetes care. This research suggests that, among diabetes patients receiving care at community health centers, patient preference or patient behaviors may be an unlikely cause of racial differences in shared decision making
Study to Examine Type II Diabetes & Race Differences in NNY
No full textA SUNY Potsdam professor and a student researcher are conducting a study, funded by the College's Kilmer Undergraduate Research Award, to examine the health status of the North Country's population.
Dr. Kelly Bonnar, an assistant professor in the Department of Community Health, and senior Samantha Paige of Norfolk, N.Y., are surveying Northern New York residents to determine whether there are disparities, or avoidable differences, in Type II Diabetes between area residents of different races and ethnicities
Improving Data Collection to Reduce Health Disparities
No full textMany racial and ethnic minorities, people with disabilities, lesbian, gay, bisexual, and transgender (LGBT) communities, and other commonly underserved populations face unique health challenges, have reduced access to health care and insurance, and often pay the price with poorer health throughout their lives.
These underserved populations are less likely to get the preventive care they need to stay healthy and are more likely to suffer from serious illnesses like diabetes and heart disease. When these populations do get sick, they are less likely to have access to quality health care. As a result, health disparities persist
Coming and Going: The Effect of Household Composition on the Economic Well-being of Families with Children
No full textAs a result of the deinstitutionalization of marriage, high levels of divorce, and an increased acceptance of
cohabitation and single parenthood, there is an ever changing array of families in American households (Stacey
1996, Thistle 2006). Current literature examines how different types of households impact the wellbeing of
families and children. Whether adults are married, cohabiting, or single has been shown to impact their life
chances and those of any children living in their household. Studies have examined changes in composition or
household instability to negative outcomes, especially among children. Unfortunately, studies that examine
differences in type of family and household composition are often limited to comparisons of unions - married,
single, or cohabiting, focusing on the parents. Similarly, the literature on the impact of change in household
composition has focused primarily on changes in relationships, such as marriage or divorce. Comparatively less
research has been done on the influence of (1) extended family members and non-relatives (roommates,
boarders) in the household, and (2) changes in household composition that are not related to union formation
among parents. Using data from two waves of the Making Connections Survey, a study of ten disadvantaged
urban communities, we examine different types of family and non-family households, the extent of change in
household composition when other household members are considered, and differences in the effect of these
types of household structures on a variety of economic measures of child wellbeing. We observe differences in
household composition beyond the traditional nuclear family and find that there are many types of households
not accounted for in conventional family studies. In fact, 45% of households with children in our sample
include some adult who is not the parent of the focal child. In addition, we find that these non-traditional
households differ along several measures of economic wellbeing. Finally, the results show that changes in the
composition of these different households impact their economic stability and, therefore, child wellbeing over
time. This research suggests the need for more recognition of these other people in children’s lives and the
complex households in which children live
Having health insurance does not eliminate race/ethnicity-associated delays in breast cancer diagnosis in the District of Columbia
No full textBACKGROUND:
Delays in follow-up after breast cancer screening contribute to disparities in breast cancer outcomes. The objective of this research was to determine the impact of race/ethnicity and health insurance on diagnostic time, defined as number of days from suspicious finding to diagnostic resolution.
METHODS:
This retrospective cohort study of 1538 women examined for breast abnormalities between 1998-2010 at 6 hospitals/clinics in the District of Columbia measured mean diagnostic times between non-Hispanic whites (NHWs), non-Hispanic blacks (NHBs), and Hispanics with private, government, or no health insurance by using a full-factorial ANOVA model.
RESULTS:
Respective average—geometric mean (95% CI)—diagnostic times (in days) for NHWs, NHBs, and Hispanics were 16 (12, 21), 27 (23, 33), and 51 (35, 76) among privately insured; 12 (7, 19), 39 (32, 48), and 71 (48, 105) among government insured; 45 (17, 120), 60 (39, 92), and 67 (56, 79) among uninsured. Government insured NHWs had significantly shorter diagnostic times than government insured NHBs (P = .0003) and Hispanics (P < .0001). Privately insured NHWs had significantly shorter diagnostic times than privately insured NHBs (P = .03) and Hispanics (P < .0001). Privately insured NHBs had significantly shorter diagnostic times than uninsured NHBs (P = .03).
CONCLUSIONS:
Insured minorities waited >2 times longer to reach their diagnostic resolution than insured NHWs. Having private health insurance increased the speed of diagnostic resolution in NHBs; however, their diagnostic time remained significantly longer than for privately insured NHWs. These results suggest diagnostic delays in minorities are more likely caused by other barriers associated with race/ethnicity than by insurance status. Cancer 2011;. © 2011 American Cancer Society